Study Finds Racial Disparity in Which Patients Receive Advanced Pulmonary Embolism Treatment

People of color are less likely to be given proper treatment for severe cases of pulmonary embolism compared to white patients, according to the findings of a new study.

Research from the Larner College of Medicine at the University of Vermont Burlington presented the study at the recent American Society of Hematology annual meeting, which suggests there are serious racial disparities in access to advanced pulmonary embolism treatments. The findings are considered preliminary until published in a peer-reviewed journal, but indicated that Black patients and Asian/Pacific Islander patients are 13% and 24%, respectively, less likely to receive potentially life-saving treatments than white patients.

The study involved a review of data on more than 1.1 million patients who were hospitalized for pulmonary embolisms from 2016 to 2018, using information from the Nationwide Inpatient Sample, which captures 20% of discharges from US hospitals. Overall, 66,570 cases were considered high-risk, including patients suffering from shock, cardiac arrest, or using a vasopressor medication, or on ventilation.

Pulmonary embolism (PE) occurs when a blood clot enters the lungs. It can lead to pain, breathlessness, and cough. If left untreated, it can be dangerous and life-threatening, but is easily treated by doctors if a patient gets treatment early enough.

Early treatment typically includes blood thinning medication, compression socks, leg elevation, and pneumatic compression. Advanced therapies used to treat PE include systemic thrombolysis, catheter-directed therapy, surgical embolectomy, and vino-arterial extracorporeal membrane oxygenation.

Rates of PE were highest among Black patients, occurring in 20 patients per 10,000 people. However, compared to white patients, the use of advanced therapies to treat PE was 13% lower among Black patients and 24% lower among Asian/Pacific Islander patients.

Researchers also found disparities in treatment among patients enrolled in Medicare and Medicaid. Patients enrolled in Medicare were 27% less likely to receive treatment and those on Medicaid were 32% less likely to receive treatment compared to those with private insurance.

In-Hospital PE Deaths Higher for People of Color

For patients who suffered from high-risk PE, all racial and ethnic groups had higher in-hospital death rates compared to white patients.

In-hospital death rates among patients with PE were 10% to 53% higher among Latinos, Asian/Pacific Islanders, and people of other racial or ethnic groups compared to white patients.

Researchers said factors related to the disparities may include racism, unconscious bias, and constraints linked to insurance status. Furthermore, many of the disparities are rooted in structural racism and other social factors that aren’t measured in health settings.

Overall, researchers are unsure why people of color are more likely to suffer from PE and present with high-risk PE. Some factors may be linked to differences in awareness of PE symptoms, less trust in the healthcare system, delayed diagnoses, delayed care, and misdiagnosis.